ARIZONA DEPARTMENT OF ENVIRONMENTAL QUALITY
OPEN BURNING PERMIT APPLICATION
(Please type or print legibly)
1.
2.
Applicant Name:
_______________________________________________________________
a.
Mailing Address: ________________________________________________________
b.
City, State, Zip:
________________________________________________________
c.
Phone # / Fax #:
________________________________________________________
d.
Email address:
________________________________________________________
Physical location of burn (Please provide one of the following)
Address:
_______________________________________________________________
City:
____________________ County: ____________________ Zip: __________
Or
Parcel Number: ________________________________________________________________
Or
Township:
3.
_______________ Range: ________________ Section: ________________
Or
Latitude/Longitude, Elevation:
__________________________________________________
Description of burning location:
[ ] Residential
[ ] Agricultural
[ ] Construction
[ ] Landfill
[ ] Fire training
[ ] Range Land
[ ] Other (state:___________________________________ )
4.
Type of material to be burned:
[ ] Brush
[ ] Grass
[ ] Crop
[ ] Weeds
[ ] Untreated Wood/Lumber
[ ] Cut tree(s), please state diameter__________Inches
[ ] Other, please explain______________________________
5.
Estimated quantity of material to
be burned:
[ ] Number of cubic yards
__________________, or
[ ] Number of piles
_______________________, or
[ ] Number of acres
________________________
6.
Material to be burned shall be:
[ ] Piled
[ ] Collected in a pit
[ ] Ignited in place (field burning)
[ ] Ditch burning
[ ] Placed in an approved waste burner
[Approved waste burner means an incinerator constructed of fire resistant material with a cover or
screen that is closed when in use, and has openings in the sides or top no greater than one inch in
diameter.]
7.
Anticipated duration per burn in hours: _______________________________________________
8.
Estimated number of days to burn all material:_________________________________________
9.
Purpose(s) of burning:
[ ] Weed abatement
[ ] Fire prevention
[ ] Range improvement
[ ] Crop removal
[ ] Others (Please explain) ___________________________________
10.
What types of actions will be taken to minimize fire emissions including any Emission Reduction
Techniques (ERTs)? ERTs include, but are not limited to:
Minimize the material to be burned;
Prevent fire from spreading by lining the area where open burn is conducted and
application of fire retardant foam, or water;
Allow the material to dry before burning;
Minimize soil content in slash piles by constructing piles under dry soil conditions or by
using hand piling methods;
Burn in piles;
Use a back fire when grass is burned; (back firing is burning in opposite direction of the
wind)
Extinguish the smoldering burns;
Burn before litter falls;
Burn prior to precipitation;
Other (Please provide a description of the techniques you will be using to minimize the
emissions from your open burning activities): _________________________________
________________________________________________________________________
11.
Burn area must be at least 50 feet from your home, our neighbors, and business.
a.
What is the distance from the burn location to your residence? ________ feet
b.
What is the distance from the burn location to your neighbors? ________ feet
c.
What is the distance from the burn location to nearby businesses? _______ feet
(Please note, permit can not be issued if the distance is less than 50 feet)
12.
Please provide a either a hand drawn map or Google/Bing/Mapquest/county assessor or parcel
map of the burn location, depicting the burn area, traveled roads, airports, and the distance from
nearby buildings/structures (including fuel tanks, gas lines) that are under your ownership or
another persons ownership. In your map, please use a line to note the distances between the burn
location and buildings/structures in feet. Please see the example:
13.
Fire controls available (e.g., water hose, shovels, dirt): __________________________________
_____________________________________________________________________________
14.
Nearest fire department: __________________________________________________________
15.
Fire department phone #: __________________________________________________________
16.
Please contact your local fire department before burning. You may be required to obtain a permit
from them, before being allowed to burn.
I certify that I have knowledge of the facts herein set forth, that the same are true, accurate and complete to
the best of my knowledge and belief. I further state that I will assume responsibility for conducting open
burning in accordance with the Arizona Administrative Code, Title 18, Chapter 2 and any open burning
permit issued thereof.
Signature: __________________________________________________________ Date: _____________
Typed or printed name of signer: ___________________________________________________________
Mailing Addresses:
If the burning is to be conducted in Apache, Coconino, Gila, La Paz, Mohave, Navajo, Yavapai or
Yuma Counties please mail/fax to:
Arizona Department of Environmental Quality
ATTN: Air Quality Division
1110 W. Washington Street
Phoenix, AZ 85007
Phone #: (602) 771-2338
Fax #: (602) 771-4346
If the burning is to be conducted in Cochise, Greenlee, Graham, or Santa Cruz Counties please mail/fax
to:
Arizona Department of Environmental Quality
Southern Regional Office
400 W. Congress, Suite 433
Tucson, AZ 85701
Phone #: (520) 628-6733
Fax #: (520) 628-6745